Chapter 24: Gynecologic Emergencies

Overview

• Focus on anatomy, physiology, and pathophysiology of female reproductive system
• Special considerations for sexual assault cases

Female Reproductive Anatomy and Physiology

• Internal Structures:
  • Ovaries: Produce eggs (ovum)
  • Fallopian Tubes: Connect ovaries to uterus, site of fertilization
  • Uterus: Muscular organ where fetus grows, cervix is the narrowest part
  • Vagina: Outermost cavity
• External Structures:
  • Vaginal Opening, Labia, Clitoris, Perineum
• Reproductive Cycle:
  • Puberty begins with menarche (onset of menstruation, ages 11-16)
  • Menopause marks the end of menstrual activity (around age 50)
  • Monthly ovulation and menstruation cycle

Gynecologic Emergencies

• Pelvic Inflammatory Disease (PID):
  • Infection of upper reproductive organs, common in sexually active women
  • Symptoms: Lower abdominal pain, abnormal discharge, fever
  • Risk factors: Multiple partners, untreated STDs, age <26
• Sexually Transmitted Diseases (STDs):
  • Chlamydia: Most common, mild or absent symptoms
  • Bacterial Vaginosis: Can lead to PID, affects ages 15-44
  • Gonorrhea: Affects reproductive and other body parts
• Abdominal/Vaginal Bleeding:
  • Causes: Menstruation, trauma, spontaneous abortion, polyps, cancer

Patient Assessment

• Scene Safety:
  • Confirm scene safety, consider police involvement if crime suspected
• Primary Assessment:
  • Evaluate airway, breathing, circulation, and level of consciousness
  • Monitor for signs of shock
• History Taking:
  • Investigate chief complaint, use OPQRST for pain assessment
  • Obtain SAMPLE history, inquire about birth control and last menstrual period
• Secondary Assessment:
  • Focus on chief complaint area, assess vital signs, and possible vaginal discharge
  • Consider orthostatic vital signs if bleeding suspected

Emergency Care

• Maintain patient privacy
• Use sanitary pads for excessive bleeding, document number of pads used
• Treat external injuries with sterile compresses

Specific Conditions

• PID Management:
  • Non-emergency transport, usually worse during normal menstruation
• Sexual Assault and Rape:
  • Complex issues involving medical, psychological, and legal aspects
  • Preserve evidence, discourage washing or changing clothes
  • Consider using a female EMT for care

Review Questions

1. Narrowest portion of uterus: Cervix
2. Outermost cavity of reproductive system: Vagina
3. Days before menstruation if no fertilization: 14 days
4. Onset of menstruation: Menarche
5. Causes of vaginal bleeding: All of the above
6. Common presenting sign of PID: Lower abdominal pain
7. Important information when obtaining history: All of the above
8. First priority with excessive vaginal bleeding: Treat for shock and transport
9. Drug commonly used in assaults: Rohypnol
10. Discourage victim from: All of the above

Conclusion

• Understanding gynecologic emergencies and appropriate EMT response
• Importance of preserving evidence in cases of sexual assault

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